Medical Staff Credentialing Coordinator
Company: Northwest Community Healthcare
Location: Arlington Heights
Posted on: June 8, 2021
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Job Description:
Shift: Full time, Days Reporting to the Director of Medical Staff Services the
Credentialing Auditor will provide operational oversight for the
quality and audit function of all practitioner's credentialing and
recredentialing files to ensure accuracy and completeness before
review by Medical Staff Leadership. This position will act as the
liaison between the Director and Medical Staff Credentialing
Coordinators. This quality-oriented product will provide rapid
turn-around for both the practitioner and the facility in a
cost-efficient manner while maintaining compliance with appropriate
state and federal laws, regulatory agencies, payers and medical
staff bylaws/rules/regulations and policies. Audits 100% of credentialing and re-credentialing files
submitted by the Credentialing Coordinators for accuracy and
completeness. This includes the auditing of data entry and scanning
in the Credentialing Database as well as documentation
submitted. Tracks and trends any errors identified as well as monthly
turnaround times. Returns audited files for corrections to the relevant
Credentialing Coordinator, for the purposes of data correction and
education. Prepares credentialing and re-credentialing files for file
review with Medical Staff Leaders and meets one-on-one with Medical
Staff Leaders, if requested. Prepares Credentialing Reports for all NCH entities to include
on their Committee Meeting Agendas and is manages and participates
in Credentials Committee meetings. Develop, implement and maintain Credentialing audit tools
annually to ensure compliance with all current Joint Commission,
NCQA, AAAHC, State and Federal requirements. Works closely with Director to meet the educational needs of the
Credentialing Coordinators and provides
in-service/orientation/education as needed. Manages annual payer delegation audits in conjunction with
Director. Assists in coordination of office workflow operations Maintains working knowledge of credentialing and recredentialing
processes and assists as necessary. Additional office duties, as needed. The level of knowledge normally acquired through completion of a
Bachelor's Degree is required. Certification by the National Association Medical Staff Services
as either a CPCS or CPMSM or become certified within 3 years of
employment. A minimum of at least 5 years of experience in a central
verification office, hospital or managed care setting. Strong knowledge of the acute care/hospital credentialing
process, including initial appointment, privilege delineation and
reappointment. Knowledge of payer delegation process. Knowledge and experience in medical/legal issues and laws and
regulatory requirements (TJC, NCQA, AAAHC, CMS Conditions of
Participation) Strong computer skills including MS Word, MS Excel and knowledge
of MSOW software credentialing system. Strong organizational skills with required attention to detail;
Ability to solve problems and resolve conflicts. Excellent oral and written communication skills with staff,
physicians and executives. Excellent interpersonal skills and ability to work effectively
and efficiently with others Ability to work independently PHYSICAL REQUIREMENTS: Requires very little physical effort. Required to walk or stand
for prolonged periods. May require occasional lifting or moving
lightweight material, or rarely lifting or moving average weight
material. WORKING CONDITIONS:
Keywords: Northwest Community Healthcare, Arlington Heights , Medical Staff Credentialing Coordinator, Other , Arlington Heights, Illinois
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